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Recruitment Services: Page 1 of 6
Recruitment Services: Page 1 of 6
Trust Headquarters
1 Armstrong Way
Southall
Middlesex
UB2 4SA
The above named has been offered the post of Bank Security Assistant and has given permission for
us to approach you for a reference. I would be grateful if you could let me have your opinion regarding
her suitability for the post by completing the attached reference request form.
Your reply will be treated in the strictest confidence and I would greatly appreciate a swift response.
It is preferred that you fulfill this request by using the on-line form available at
https://apps.trac.jobs/references/ using the reference ID 17211911 / NK66030302. Alternatively you
can print out the attached form and return it to us by fax to 03333 44 88 22.
If you do not want to use the online system or the form provided please reply to this email with your
own form or letter attached.
It should be noted that under the Data Protection Act candidates may request access to any
information that is held on them.
May I take this opportunity to thank you in anticipation of your assistance in this matter.
Kind regards,
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To fill out this form on-line, please visit https://apps.trac.jobs/references/ and enter the following reference ID:
17211911 / NK66030302
Alternatively, you may return this form by faxing it to 03333 44 88 22.
Please include only one form per fax, and use "fine" or "superfine" mode where possible.
Applicant details
Applicant name Miss Raybel Romani Post applied for Bank Security Assistant
Colmenares Rodriguez [222-Bank-05]
Reference form
Please provide details of Raybel's sickness record over the last two years of employment
Number of occasions
Comments
The post is exempt from the provision of Section 4 (2) of the Rehabilitation of Offenders Act, 1974 by
virtue of the Rehabilitation of Offenders Act (exceptions) Order 1975. Applicants must therefore declare
all cautions, criminal convictions, criminal convictions pending, warnings or reprimands both within and
outside of any ‘unspent’ period.
Declaration
Your name
Organisation name
Address line 1
Address line 2
Address line 3
Town / city
County
Postcode
Country
Telephone
Fax
Email address
The above information has been provided without prejudice and is correct to the best of my knowledge and
belief.
Data protection
This form contains personal data as defined by the Data Protection Act 2018 (as amended by the General Data
Protection Regulation 2018). This data has been requested by West London NHS Trust exclusively for the purpose
of recruitment. West London NHS Trust must protect any information disclosed within this form and ensure that it is
not passed to anyone who is not authorised to have this information.